Targeting consumers.Connecting online.
What’s in store for patients.
TABLE OF CONTENTS
15 years of DTC
AD SPENDING: 15 YEARS OF DTC
- MEDIA SPENDING: 1996 TO 2010
- LARGEST PHARMA ADVERTISERS
- MEDIA SPENDING BY CATEGORY
- MOST-ADVERTISED PHARMA BRANDS
- PHARMA ADVERTISING BY MEDIUM
- HEALTH-CARE REFORM
WEB MARKETING CHALLENGES
- TIME SPENT ON PHARMA SITES
- LARGEST PHARMA INTERNET ADVERTISERS
SOCIAL MEDIA AND HEALTH
- SHARE OF DISCUSSION
- HOW DIABETES-RELATED BRANDS
RESONATE IN SOCIAL MEDIA
PHARMACIES AND PHARMACISTS
- FIVE MOST-VALUED SOURCES FOR
- BABY BOOMERS TAKING ON NEW HEALTH-CARE
- MOST-PRESCRIBED PHARMACEUTICALS
BY BETH SNYDER BULIK
it’s been almost 15 years since U.S. direct-to-consumer advertising regulations were loosened.And in those years, the consumer
pharmaceutical marketing industry has gone from about $700 million in ad spending to a peak of $5.4 billion in 2006. Spending in
2010—about $4.3 billion—was down, but pharmaceutical advertising remains a big business.
Before 1997, pharma marketers were allowed to name a brand
in an ad—but with the onus of the “brief summary,” a summation
of side effects, contraindications and effectiveness usually written
technically and typically anything but “brief.” Ads appeared in
print, but the summary mandate would have made TV ads too long.
FDA guidance, introduced in 1997 and formally adopted in 1999,
allowed TV ads to name a pharma brand and the condition it treated without the summary. Instead, TV ads were required to include
a “major statement” of the most important risks with a referral to
a source of in-depth information. That led to the explosion of DTC
advertising, mostly in TV.
Pharma marketing is in flux again. The meteoric rise of digital
information and social-media channels, the still-evolving regulatory environment, the maturing of mainstream blockbuster drugs,
and fewer new drugs being brought to market all point to a major
inflection point in pharmaceutical marketing.
Change means new opportunities. Globalization, personalized
medicines and therapies, the potential for niche drugs, and diversification into broader health-care portfolios are all potentially positive side effects pointed out by the experts interviewed for this
“This industry is in massive transition,” said Nick Colucci, president-CEO, Publicis Groupe’s Publicis Healthcare Communications
Group. “The health-care industry in general is changing, going
from broad-based to targeted therapies. Like any evolution and
change, there are some players that will come out stronger and
there are some that will disappear. … The future is all about products that will be more targeted, products that will be used, ultimately, just for you.”
What does that mean for advertising and marketing of pharmaceuticals? It means that will have to change as well. Change is
already happening. Health-care standalone agencies are no longer
standoffish in agency families and instead are being reintegrated
into the larger group or broadened into wider agency networks.
WPP’s Grey Group recently created Grey Healthy People, a
“specialized unit totally integrated within the overall agency” and
meant to house not only its DTC and over-the-counter clients, but
also broader health-care clients including personal-care products
such as toothpaste, mouthwash and tampons.
1. U.S. Department of Health and
Human Services. Includes spending
by consumers, insurance companies,
government and various third
2. Kantar Media for 17 measured
This is one in a
series of white
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PHARMACY BENEFITS MANAGERS
- LARGEST FIRMS
- PRESCRIPTIONS FILLED BY PBM
- PRESCRIPTIONS FILLED WITH GENERICS
- HOW WELL PHARMACEUTICAL
ADS RETAIN VIEWERS
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| October 17, 2011 | 3
Indeed, the agency executives Ad Age interviewed agreed that
those silos of DTC ad specialists won’t work with the changing
landscape. Most of the industry embraces the idea of broader
“The role of agencies as mediator, negotiator, liaison and ultimately ambassador between pharmaceutical companies,third parties
that have the trust, and academics and researchers that
have the clinical knowledge and understanding … that’s
where we can help usher in that new era.That’s the value
we can provide,” said Michael Spitz, VP-digital strategy,
inVentiv Health’s Ignite Health.
AstraZeneca’s Seroquel, Takeda’s Actos and Forest Laboratories’
Lexapro. However, the end of those drugs as brands, while dramatic, is not a death knell for any company and certainly not the
end of the pharma ad industry.
“It’s incredibly short-sighted, but a lot of people are saying the
sky is falling because Lipitor is going off patent,” said Ned
Russell, managing director, Publicis Groupe’s Saatchi &
Saatchi Wellness. “Yes, some blockbusters are going
generic, but there are so many other things going on.
There are great opportunities, but it’s just not a $150
million ad campaign for Lipitor or Plavix or whatever.
It’s more about targeting to patients who have specific
needs. … It’s also about proactive health. It’s more of a
journey where marketing communications plays a role
in advising and helping the consumer along.”
but a lot of
the sky is
AD SPENDING CHANGES
U.S. measured-media ad spending by pharmaceutical
marketers, mostly in the traditional areas of TV and
print with digital claiming only a minor share of what
most marketers spend, peaked at $5.4 billion in 2006,
according to WPP’s Kantar Media. Spending has
declined every year since then to $4.3 billion in 2010, a
decrease of almost 20% over five years. Year-over-year
ad spending from 2009 to 2010 alone dropped 8.8%.
Pharmaceutical companies are spending less on
marketing for several reasons including some heavily
marketed drugs that have gone off-patent, a smaller
pipeline with fewer new drugs coming to market and
more skeptical consumers. But the main reason
they’ve cut back is, like many other companies and
consumers in the recession and tepid recovery, they
simply have less to spend.
That’s not likely to change anytime soon. Along with fewer
groundbreaking mainstream drugs, the dreaded “patent cliff” is
looming with even more blockbuster—and heavily marketed—
prescription drugs set to lose their patents and go generic. Pfizer’s
Lipitor leads the pack in November 2011, but it will be followed
in 2012 by Bristol-Myers Squibb’s Plavix, Merck’s Singulair,
IMPERATIVE TO CREATE BRAND VALUE
Mark Goldstone, president of Omnicom Group’s DDB
Health, said marketing will have to change along with
the industry. The old way, when innovation in the form
of a breakthrough drug or treatment sold the product,
is gone. Major mainstream breakthroughs are few and
far between. It will be up to agencies to help marketers
“The difference between the old and the new drugs
was great. So the drug rep went into the doctors and
explained that, then took them to lunch, took his whole
family to Disney, and sales went up,” Mr. Goldstone
said. “They didn’t have to create value, like bottles of
water have to. That was created in the lab, and reps would do the
rest. … Now everyone is under pressure, the new drugs may
only deliver a small benefit, and the drug rep has to go in and
explain why that justifies the expense. And oh, I can’t leave you
a pen anymore, I certainly can’t take you to lunch, and there is
definitely no Disney.”
PHARMACEUTICAL MEDIA SPENDING: 1996 TO 2010
By U.S. measured-media ad spending.
DOLLARS IN BILLIONS
Source: Kantar Media. Totals are for 17 measured media: network TV, spot TV, cable TV networks, Spanish-language TV networks, syndicated TV,
consumer magazine, Sunday magazine, Spanish-language magazine, local magazine, newspaper, national newspaper, Spanish-language newspaper,
national spot radio, network radio, local radio, outdoor and internet display (excluding search and broadband video).
| October 17, 2011 | 5
25 LARGEST PHARMACEUTICAL ADVERTISERS
By 2010 U.S. measured-media ad spending in 17 media. Dollars are in millions.
2 . Eli Lilly & Co., Indianapolis
3 . AstraZeneca, London
4 . GlaxoSmithKline, London
5 . Bristol-Myers Squibb Co., New York
6 . Merck & Co., Whitehouse Station, N.J.
7 . Johnson & Johnson, New Brunswick, N.J.
8 . Allergan, Irvine, Calif.
9 . Abbott Laboratories, Abbott Park, Ill.
10 . Roche Holding, Basel, Switzerland
11 . Takeda Pharmaceutical Co., Osaka, Japan
12 . Sanofi-Aventis, Paris
13. Dainippon Sumitomo Pharma Co., Osaka, Japan
14 . Boehringer Ingelheim, Ingelheim, Germany
15 . Novartis, Basel, Switzerland
16 . Shire, Dublin
17 . Bayer AG Group, Leverkusen, Germany
18 . Amgen/Pfizer, Thousand Oaks, Calif.
19 . Astellas/GlaxoSmithKline, Tokyo
20 . Galderma (L’Oreal/Nestle), Lausanne, Switzerland
21 . UCB, Brussels
22 . Teva Pharmaceutical Industries, Petach Tikva, Israel
23 . Auxilium Pharmaceuticals, Malvern, Pa.
24 . Ferring Pharmaceuticals, Parsippany, N.J.
25 . Novo Nordisk, Bagsard, Denmark
1 . Pfizer, New York
Source: Kantar Media. Totals are for 17 measured media: network TV, spot TV, cable TV networks, Spanish-language TV networks, syndicated TV, consumer magazine, Sunday magazine, Spanish-language magazine,
local magazine, newspaper, national newspaper, Spanish-language newspaper, national spot radio, network radio, local radio, outdoor and internet display (excluding search and broadband video).
6 | October 17, 2011 |
Innovation is still there, just in more niche audiences. Cancer
treatments, for instance, show promise as areas where drug companies can innovate for smaller audiences of patients.
Exacerbating the market difficulties is the unique position the pharma industry is in when it comes to federal regulations. It is a very regulated industry, from
research, development and testing of new drugs to
marketing those drugs. While regulations are there for
a good reason, they also are an additional challenge.
That’s particularly true now that the consumer world
has gone totally tech and pharma companies are hampered in their efforts, partly by their own concerns of
sanctions and partly by the fact that there are no real
guidelines for digital marketing given by the FDA.
“How do we become a customer-centric industry
when we’ve never been one before? Outside of OTC, the
focus in DTC has been on physicians. We’re not a direct
seller, not an online pharmacy and we’re not selling
Tylenol,” said Fabio Gratton, chief innovation officer at
Ignite. “A company is a company is a company, but yet
pharma has its hands tied a bit.”
Pharma companies will have to market online.
“Budgets are shrinking, physicians are more skeptical and have less time for reps, and pharma has less
money to spend. Pharma almost has no choice but to
turn away from expensive media channels and embrace
the more economical digital channels,” Ignite’s Mr. Spitz said.
those ads may change, though.
“TV, magazines and journals will continue to have a role, and it
will still be appropriate to communicate through those media. But
that focus will be more on the appropriate use, the continued use
and adherence (to a prescribed medicine),” DDB’s Mr. Goldstone
said. “Fewer than 50% of people on cardiovascular products take
their medicine regularly. … There’s a lot of work to be
done around adherence and compliance. Connect with
their physicians through advertising or an introduction
to a website, then you’re connected, and the CRM (customer relationship management) connection is made.
‘Welcome to the use of the product’ with robust programs behind that.”
traditional Perhaps the biggest challenge pharmaceutical companies
is in building a more direct relationship with the conmedia will face
sumer. Some won’t attempt to do it—whether in fear of
FDA reprisal or a corporate philosophy that they are science and research companies, not marketers. One agency
executive reports a senior pharma executive said—in a
recent tweet chat on mobile health—that he believes
of the ads pharma companies should stay out of mobile health ad
may need campaigns
Some pharma marketers have jumped right in.
Mr. Gratton pointed to a social-media effort Ignite
So what will happen to TV and print advertising, with their long
and sometimes off-putting explanations of side effects and potential problems, when the money moves online in the pharmaceutical industry? Like many other industries where the change has
already occurred, traditional media will survive. The function of
created for Novo Nordisk with the Juvenile Diabetes
Research Foundation to develop a vibrant patient community, Juvenation, a peer-to-peer social group for people with
type 1 diabetes. Launched in November 2008, the community now
has 14,000 members, according to its Facebook page.
“We’ve all heard what’s happening now called things like
‘Pharmaggedon,’ but there are also many people who are excited
by all the changes.They’re experimenting, maybe failing, and trying again.They’re creating campaigns by listening and opening up
channels and trying everything they can to understand consumers today,” Mr. Gratton said.
PHARMACEUTICAL AD SPENDING BY CATEGORY IN 2010
U.S. measured-media ad spending of $4.3 billion by condition.
Sleep disorder 1.3%
Stomach 1.1% ($49 million)
Impotence 7.3% ($316 million)
Allergy, asthma 7.8% ($339 million)
and other 40.7%
Arthritis 10.1% ($437 million)
Heart, blood pressure and
cholesterol 14.3% ($620 million)
Mental health 14.8%
Source: Kantar Media. Conditions listed based on Kantar Media classifications for prescription drugs and pharmaceutical houses. Over-the-counter medications are excluded.
| October 17, 2011 | 7
25 MOST-ADVERTISED PRESCRIPTION DRUGS
By 2010 U.S. measured-media ad spending in 17 media. Dollars are in millions.
RANK PHARMACEUTICAL, MARKETER
2 . Cialis, Eli Lilly & Co.
3 . Cymbalta,Eli Lilly & Co.
Mental health, depression
4 . Advair, GlaxoSmithKline
5 . Abilify, Bristol-Myers Squibb Co.
Mental health, depression
6 . Symbicort, AstraZeneca
Asthma, COPD, respiratory
7 . Pristiq, Pfizer
Mental health, depression
8 . Plavix, Bristol-Myers Squibb Co.
9 . Chantix, Pfizer
10 . Lyrica, Pfizer
11 . Toviaz, Pfizer
12 . Viagra, Pfizer
13 . Crestor, AstraZeneca
15 . Lovaza, GlaxoSmithKline
16 . Seroquel, AstraZeneca
20 . Simponi, Johnson & Johnson
21 . Januvia, Merck & Co.
22 . Restasis, Allergan
23 . Vyvanse, Shire
24 . Trilipix, Abbott Laboratories
25 . Lunesta, Dainippon Sumitomo Pharma Co.
1 . Lipitor, Pfizer
Boniva, Roche Holding
18 . Spiriva HandiHaler, Boehringer Ingelheim
Singulair, Merck & Co.
High cholesterol (triglycerides)
Mental health, depression
Asthma, allergy, respiratory
Chronic dry eye
Source: Kantar Media. Totals include 17 measured media. Ranking based on Ad Age DataCenter analysis. Some pharma brands are co-marketed. See P. 5 and P. 7 for notes on measured media.
8 | October 17, 2011 |
PHARMACEUTICAL ADVERTISING BY MEDIUM IN 2010
U.S. measured-media ad spending of $4.3 billion for medicines and pharmaceutical companies.
Spot TV 2.4%
Internet (display) 4.7%
Syndicated TV 8.1%
Cable TV networks 12.7%
TV networks 31.5%
Source: Kantar Media. See P. 5 and P. 7 for notes on measured media.
>> HEALTH-CARE REFORM
President Obama’s health-care reform law,
passed in March 2010, is a looming pill for
insurance companies, doctors, hospitals and
the entire health-care system.
The main drug-related shift under the
Affordable Care Act is that the government—
already the biggest pharma customer—may
become an even bigger one as a vastly larger
percentage of Americans become insured.
For pharma marketers, that means the
government will have more influence over
One question is how off-label drug use
will be covered. Drugs are used off-label to
treat many diseases. That means a drug is
not specifically approved, or has not been
through the rigorous approval process, for a
particular use. The American Cancer Society
says off-label use is common in treating
cancer. But it can already be difficult to get an
insurer to reimburse or pay for an off-label
“The question is what are the policies for
off-label use,” said Wayne Pine, a pharma
industry consultant and former FDA chief
spokesman. “At one extreme, and it is an
extreme, government could prohibit any use
or reimbursement for a product being used
off label. That is an extreme, of course, and I
don’t think they will end up there.”
Decisions now on off-label coverage are
made by the government on a case-by-case
basis . That could continue, or an overarching
policy could be established, he said.
The next biggest customer of pharma
companies after the government is the
primary payer group of managed care and
insurance companies. That’s where healthcare reform tends to move decision making,
said John Kamp, executive director, Coalition
for Healthcare Communication.
“The pharma business has to respond by
looking at its newest customers. The FDA
rules are aimed at regulating what drug
companies can say to doctors and
consumers, but there isn’t much thinking
about how to interact with payers and the
government,” he said.
Moreover, marketers will need to reach
new prescription drug consumers —the more
president of Kantar Media’s Campaign Media
Analysis Group. “We still live in a world, even
with the internet, where people still spend
more time watching TV, and even more so
with older people, TV draws big eyes.”
Pharma, however, will face another
challenge as the health-care reform act is
established because while it is a national law,
some money and administration are filtered
down through the states.
“On multiple issues and at multiple levels
of government, pharma companies are
going to have to be involved with
government relations,” Mr. Goldstein said.
There also are some direct costs in the
act, in the form of new
annual taxes to be levied at
the pharma industry, paid
based on market share.
Those taxes are set to
begin next year with $2.8
billion to be paid in 2012
and 2013; $3 billion in 2014
through 2016; $4 billion in 2017; $4.1 billion in
2018; and $2.8 billion in 2019 and beyond,
according to the Kaiser Family Foundation.
Of course, that is if health-care reform
Recent court challenges to the reform
act by states have made their way through
the local and regional courts and are likely
headed to the Supreme Court, with several
states, state groups and even the Obama
administration asking recently for a review
by the high court.
Many questions remain. How much
off-label use will be covered? What
role will the states play? Will the new
law survive high court review?
than 30 million people who had previously
been uninsured. Combined with the more
limited access to doctors, not by health-care
reform but by hospital policies or simply
physicians’ time constraints, pharma seems
to have more reason to advertise directly to
“Pharma companies will still try to reach
doctors through salespeople and
professional publications, but also in the
same way they reach consumers. Doctors
watch TV, too,” said Kenneth Goldstein,
| October 17, 2011 | 9
Web marketing challenges
everyone’s looking online for health information.
In fact, research shows that a majority of people turn to the web
first when looking for health information. Not just at some point,
but “first.” That means about 57% of the online population turns
to the internet before talking to their doctor, spouse, friends or even
their mom when looking for information. And about 82% of people deem access to online tools and health information as “critical,”
according to Kantar Media’s 2011 MARS Online Behavior Study.
Physicians are also increasingly going online. Whether looking
for the latest research or treatment information, 86% of medical
professionals read journals online, and another 80% use reference
publications on the internet, according to Kantar Media’s 2011
MARS Physician Sources & Interactions Study.
Hospitals use the internet to give information about their services, create patient groups and build wellness communities around
their brands. Boston University Medical Center, for instance, has
developed a strategy that includes online virtual patient advocates
to help reduce patient re-hospitalization after discharge.
So it would seem that pharmaceutical marketers would also be
somewhere in the mix, just as they are in the offline mix of healthcare information. But in general, they’re not.
Already a cautious industry, pharmaceutical marketers are concerned about violating regulations, crossing privacy lines or appearing too aggressive to consumers. They also tend not to be experienced in digital marketing. So the net effect for these marketers is
that they either can’t, or won’t, go where many people and medical
communities already are.
Pharma companies do play some role online, of course. Many
place paid search advertising, and others buy display ads on medical
community web pages. They maintain branded drug websites
detailing things like the drug’s usage, risks and rewards, for instance.
However, the more forward-looking one-to-one marketing written
about so much in other industries is virtually unheard of.
“When I read stories about what hospitals and doctors are doing
online, I wonder why can’t pharma do similar kinds of things?” said
Ned Russell, managing director of Publicis Groupe’s Saatchi &
Saatchi Wellness. “When it comes to digital and social, because of
things like adverse reporting, they generally just don’t do it.”
Adverse reporting—the Adverse Event Reporting System—is a
U.S. Food and Drug Administration program intended to monitor
negative effects attributed to prescription drugs. Filing reports is
voluntary for health-care professionals and consumers. However,
pharma marketers are mandated to report. The FDA website reads:
“If a manufacturer receives an adverse event report, it is required to
send the report to FDA as specified by regulations.”
The fear is that web communications, such as blog postings by
visitors to a pharma-hosted or -sponsored site or comments on a
pharma social-media page, could fall under that mandate.
Several studies have shown that only a small percentage of
online pharma-related comments met all the criteria requiring a
company to report. But the onus of monitoring and reporting has
kept many pharmaceutical marketers from trying.
10 | October 17, 2011 |
TIME SPENT ON PRESCRIPTIONDRUG WEBSITES
Ad Age asked Kantar Media Compete to look at web traffic and
engagement on sites for prescription drugs focused on five
conditions: arthritis, cancer, depression, diabetes and high
Site selection was limited to websites averaging more than 10,000
monthly unique visitors from August 2010 to August 2011.
The table below shows the top three in each category by average
minutes per page per session over the same time period.
TIME ON PAGE
PER SESSION 1
1. In minutes. Source: Kantar Media Compete. Ad Age DataCenter analysis.
When Facebook changed its rules in August 2011 and required
all Facebook pages to enable comments, some pharmaceutical marketers shut down their Facebook pages for just that reason. Others
have posted warnings and reserve the right to disable comments,
although some noted that kind of policy can hamper the building of
trusting two-way relationships.
But still others are trying and are getting kudos for effectiveness.
Boehringer Ingelheim is often cited as a pharma example of the
right way to do Facebook. Visitors land on a “welcome” page, versus the typical straight to wall postings on most pages.
On the welcome page, the pharma company explains its
Facebook mission and policies in a friendly casual manner.The page
reads in part: “We have enabled our wall for commenting because
we want to hear from you! Help us to keep this wall interesting by
actively contributing in the spirit it’s intended for but please respect
the following otherwise our lawyers will be mad at us.”
Boehringer Ingelheim lists and offers a rationale for its posting
“The company reserves the right to remove any postings at its
sole discretion (we work with serious medical conditions and we
can’t risk unmonitored or unverified medical advice being published).” A disclaimer/caution about not using the site as a substitute for professional medical advice adds:“We know a lot of doctors
and trust us—they know about health!”
AstraZeneca is another drug maker attempting to connect in the
social-media space. In 2011, it held the first pharma-hosted Twitter
chat (on the subject of prescription savings plans) and continues to
keep an active Twitter voice. The drug maker also maintains a blog,
Facebook page and YouTube channel.
AstraZeneca laid out its position on social media in a 2010 white
paper that said in part:
“AstraZeneca believes that we have an obligation to participate
in social media in a responsible way to help educate patients, caregivers, health-care providers and the general public. Our active participation can provide information to help ensure that patients get
the appropriate medicine at the right time and that it is taken in the
right way. As we await FDA guidance and determine the appropri-
ate path forward for AstraZeneca,outreach to other individuals who
engage in this arena—patients, caregivers, health bloggers, media
stakeholders—simply makes sense; it has helped inform and shape
AstraZeneca’s perspective on key issues.”
LACK OF GUIDELINES
Adverse-reporting regulations create a challenge for pharma firms
in social and digital media that marketers in other industries don’t
face. But it is the lack of digital guidelines that seems to frustrate
pharma marketers even more.
The FDA held a two-day hearing with physicians, marketers and
other industry experts regarding web and social-media advertising
in fall 2009 in Washington, D.C., but no guidelines have been issued
from that. Most of the comments and notices issued by the FDA
since then have been vague and haven’t offered a specific timetable.
An FDA spokeswoman in October 2011 said: “Policy and guidance development for promotion of FDA-regulated medical products using the internet and social media tools are among our highest priorities. Despite our limited resources and increasing workload, we remain committed to this area in terms of both time and
The spokeswoman added: “It is difficult to provide a timeframe
for the issuance of our guidances due to the extensive work and
review process, or ‘Good Guidance Practices,’ which ensures that
FDA’s stakeholders are provided well-vetted guidances articulating
FDA’s current thinking on a topic.”
The FDA has identified these issues as “important to address”:
responding to unsolicited requests; fulfilling regulatory requirements when using tools associated with space limitations; fulfilling
post-marketing submission requirements; online communications
for which manufacturers, packers or distributors are accountable;
use of links on the internet; and correcting misinformation.
“We are developing multiple draft guidances to address these
topics to benefit industry and the public by ensuring that these draft
guidances are meaningful and well thought out when they are
issued,” the spokeswoman said.
LARGEST PHARMACEUTICAL INTERNET DISPLAY ADVERTISERS
U.S. spending by company for corporate pharmaceutical campaigns and prescription drugs. Dollars in millions.
INTERNET AD SPENDING
Eli Lilly & Co.
Merck & Co.
INTERNET AD SPENDING
Bristol-Myers Squibb Co.
Dainippon Sumitomo Pharma Co.
Takeda Pharmaceutical Co.
Source: Kantar Media. Ad Age DataCenter analysis. Figures exclude search and broadband video. Numbers rounded.
| October 17, 2011 | 11
The FDA has a tough job in regards to the web and social-media
guidelines. Not only are new technologies constantly emerging, but
the import of the task—regulating drugs that affect people’s health
and well being—is not as easy as regulating laundry detergent or
soft drinks. Industry experts interviewed for this white paper do
realize and respect that. But they await formal guidance.
“We’ve been holding our breath waiting for them to tell us what
we can and cannot do,” said Buddy Scalera, VP-interactive content
and market research, WPP’s Ogilvy CommonHealth. “We try to
apply the offline rules online, but that doesn’t always translate. …
Some of the other guidance we do have comes from the reactions
of the FDA to something a marketer has done.”
He is referring to warning letters the FDA sends to inform a
marketer it has violated policy. For example, the FDA sent Novartis
a letter in July 2010 requesting that it remove a Facebook share
widget for leukemia treatment drug Tasigna because Novartis did
not disclose all risk information at the widget site. A link to more
information was not sufficient, the FDA stated in the letter.
The FDA issued a less serious “untitled letter” (also called a
notice of violation letter) to Pfizer in August 2011 about a Lipitor
web page where an “online resources” section mentioned other
Pfizer drugs: Caduet, Chantix and Norvasc.The drugs listed included links to more information but not a full list of risk disclosure.The
FDA deemed that disclosure insufficient.
Those FDA communications indicate that when it comes to the
web, no shortcuts are allowed in explaining risks. Just like in traditional-media advertising, it seems to say via these letters, a detailed
disclosure of risks must be presented.
Meanwhile, some marketers and industry advocates are coming
up with their own rules for web and social media.
“Waiting for the stone tablet to come down from the mountain
is probably not going to happen, so we will develop best practices
ourselves,” said John Kamp, executive director of Coalition for
Healthcare Communication, referring to the new Digital Health
Coalition. That group, made up of a broad swath of health-care
company executives, is drafting its own best practices and plans to
put them out for public comment by the end of 2011 with the goal
of publishing the voluntary guidelines by the end of 2012.
WEB AND SOCIAL MEDIA ARE FUTURE FOR PHARMA
The coalition is pushing forward, despite no clearcut FDA guidelines,because it believes that pharma must find a way to use the web
and social media to connect with consumers. As is the case in many
industries, the voice of the consumer is becoming an important part
of the brand, and the era of one-way messaging is over.
“All of the sudden, companies are looking at health care in a very
different way than they used to. Social media and mobile health are
just triggers that are pushing it,” said Fabio Gratton, chief innovation officer at inVentiv Health’s Ignite Health. ”The real opportunity is to be a complete service provider. It’s drugs versus health care.”
Mr. Gratton said there are two ways of thinking about the
changes in pharma and the web. One group is already out there
experimenting—failing sometimes, but always trying—to reach
consumers in new ways.The other, afraid or uninterested in becoming consumer-centric, will likely pull back and stick to drug R&D.
No matter which direction a company goes in online marketing,
two key web issues—privacy and brand safety—will be even more
important in the heavily regulated pharma industry.
12 | October 17, 2011 |
“There’s probably going to have to be a lot of opting in, and
‘real’ informed consent, if you will,” said Mark Goldstone, president of Omnicom Group’s DDB Health. “But it’s not just that
pharma or health care is behind the times. It’s not a lacking of
wanting. It’s the delicacy of it.”
You can see by spending patterns that drug firms are treading
lightly. Web spending is still a tiny part of pharma companies’ U.S.
ad spending. About $203 million was spent on internet display ads
in 2010 out of a total $4.3 billion, according to Kantar Media data.
Pfizer,the top-spending pharma at $967.5 million in 2010 measured
media, spent an estimated $28.6 million on internet ads, or 2.8%.
DO CONSUMERS CARE?
While pharma tends to sit cautiously on the sidelines, consumers
have rushed ahead in searching the web for health information.
However, the vast majority of consumers visit so-called non-branded websites—sources of information such as WebMD—rather than
pharma branded websites (sites run by drug companies).
In fourth-quarter 2010, of the 6.5 million unique visitors to all
websites about cancer, only 276,000 (about 4.2%) were to branded
sites, according to Kantar Media Compete data. Compete also found
low single-digit percentages for such other health conditions as
diabetes, depression, high cholesterol and rheumatoid arthritis.
Another metric from Compete looks at the time spent on specific
branded drugs’ websites. Time spent varied from as little as about
two minutes per web session to as high as eight minutes.
That may not seem like a long time to spend on a site. But if you
take into account the likely large volume of people who click away
from the page immediately, an “average time of four to five minutes by any industry’s standards is not bad,” said Ogilvy
CommonHealth’s Mr. Scalera. “On a lot of consumer sites, two to
three minutes is average.”
It’s also probably a more qualified or quality amount of time
spent, Mr. Scalera said. By the time consumers go to a prescription
drug page, they have had symptoms, seen a doctor, likely were tested and have been prescribed a medicine that is now a part of their
lives either temporarily or permanently.
So what’s a pharmaceutial marketer to do? While even the taint
of FDA warning letters is a potential public relations problem,
there is also the potential danger that too many warning letters
could lead to an FDA shutdown on marketing a drug while claims
are investigated. That represents not only lost revenue to the marketer, but also the loss of a drug a patient might need to treat a serious medical condition.
Insiders said drug companies are going to need to get creative—
not only to maneuver through the digital-marketing landscape, but
also in the new lay of the land that will be the pharma industry.
Nick Colucci, president-CEO of Publicis Groupe’s Publicis
Healthcare Communications Group, cited an example of Johnson &
Johnson’s Realize gastric band.
J&J realized that the band alone doesn’t work because diet and
behavior modification are needed as well. The company created an
online tool that patients—and their doctors and surgeons—could
use to monitor diet and exercise.After one year, J&J found the more
the online tool was used, the more weight was lost and kept off.
Said Mr. Colucci: “Clients are going to have to be more insightful and creative in thinking about what the product can do and go
beyond the obvious.”
Social media and health
Data show more discussion of general conditions than brands.When DTC branded
campaigns are mentioned,posts tend to be negative in all forms of social media.
a large percentage of medical condition-related conversations
in social media are “unbranded” (discussions where no specific
branded medication is mentioned). Across several therapeutic
areas, only about 1% mention direct-to-consumer ad campaigns.
Most discussions related to branded DTC campaigns take place
on blogs and forums. “The emotional and psychological toll of the
condition is touched upon frequently,” according to a Kantar
Media Cymfony study. The second-quarter 2011 study examined
social-media conversations about brands and patient response to
DTC posts increase with new campaigns; campaign frequency;
launch of a key partnership with a celebrity; and unique storylines. This trend is particularly visible in patient-generated posts
on Facebook and Twitter. When posts do mention specific campaigns, consumer sentiment tends to be negative—with large
doses of ridicule directed at the list of potential side effects.
A Facebook post illustrates consumer confusion and concern:
Regarding a branded campaign for what a poster called a psoriasis
“cream”, the post noted, “it can increase your chances of cancer or
heart attacks. Guess people will be sticking to the scratching.” The
post was for an injectable medicine.
Nevertheless, social media can assist pharma marketers and their
agencies with insights into positioning, consumer response and targeting. A look at diabetes-related discussions (bottom) shows the
volume of posts and multiple brand mentions. For example, Lantus
was mentioned in social-media posts 40,998 times during 2009 and
2010. Of those, 8% also mentioned Levemir.
SHARE OF DISCUSSION
Among all diabetes forum posts in 2009 and 2010.
Source: Kantar Media Cymfony.
DIABETES-RELATED BRAND NAMES MENTIONED IN FORUMS
Ranked by number of posts in 2009 and 2010. Table shows percentage of posts about a brand that mentioned other diabetes drug brands.
Source: Kantar Media Cymfony. Figures in red indicate highest resonance. Resonance indicates the presence of a discussion topic within a discussion set. For example, resonance of Byetta
against Lantus means how often Byetta is mentioned within all posts about Lantus. The % means what percent of Lantus posts contain a mention of Byetta.
| October 17, 2011 | 13
Pharmacies and pharmacists
americans submit almost four billion drug prescriptions every
year, with an average of more than 12 prescriptions per person,
according to the Kaiser Family Foundation.
While a growing number of those orders are filled by mail order,
the vast majority of prescriptions are still filled at pharmacies, either
traditional ones or increasingly at pharmacies inside supermarkets
and mass merchants.
And that makes the pharmacy, and the pharmacists themselves,
a key cog in not only the pharmaceutical chain, but also in the marketing of prescription drugs and services. The pharmacy is quickly
becoming the hub of American health care.While people may see a
doctor or go to a hospital three to four times a year, they likely make
more trips to the pharmacy for those prescriptions and refills along
with other health-care needs.
“Statistics say that as a member of the healthcare team, the
pharmacist is seen more than any other member. That gives them
a unique opportunity to interact with patients and customers,” said
Mark McCoy, senior VP-brand planning at inVentiv Health’s Palio
and a registered pharmacist for 30 years.
The role of the pharmacist has been expanding, too, as patients
see their doctors less often and take on more decision making, as an
aging population begins to take more and multiple drugs, and as
generics become more popular but also more confusing as a choice
for consumers. The former reactionary role of pharmacists has
become a much more proactive one.
Consider that many pharmacies offer vaccines and immunizations, such as flu shots, which are now allowed to be given by pharmacists in all 50 states. Some pharmacies now also provide quick
emergency care in the growing trend of minute clinics or ready care
operations inside the store that can provide convenient visits and
pain relief. It all adds up to a pharmacy renaissance, harkening back
to the small trusted local pharmacies of yesteryear.
Consumers do trust them, and in fact, pharmacists rank near the
top of the most-trusted professions at No. 3 on Gallup Poll’s annual Honesty and Ethics of Profession with 71% of people agreeing
that pharmacists are honest and ethical in 2010. Only nurses (81%)
and military professionals (73%) ranked higher. Medical doctors
were No. 5 at 66%.
Some retail pharmacy brands are recognizing that as well, and
have become more aggressive marketers, reaching out to consumers with messages of saving money, convenience and a ready
staff of helpful, knowledgeable pharmacists.
Target’s “Ask Us” campaign for its in-store pharmacies began in
2009 and morphed into “Ask Me” this year, and is a great example
of that. At the core of the message and creative work are Target
pharmacists. Clad in signature Target red shirts and traditional
pharmacist white jackets, they dispense friendly smiles along with
the encouragement to “Ask me anything about anything.”
“We needed to drive awareness for our pharmacies. At that
point, we had won two or three J.D. Power awards, but the categories more associated with Target are style and fashion,” said Will
Setliff, senior VP-marketing, Target Corp. “With health care as an
14 | October 17, 2011 |
FIVE MOST-VALUED SOURCES FOR
By the percent of respondents who answered:
3. Nurses,physician assistants
4. Friends, spouse,other relatives
5. In-doctor’s-office ads,brochures,
Source: Kantar Media’s 2011 MARS OTC/DTC Study, 2011 versus 2002. Respondents were
asked to indicate the value of certain sources for health-care information.
emerging business for us, we needed to develop a message and marketing that didn’t mimic the fashion side or other parts of our business. We already had these highly educated, passionate team members (in pharmacy), so we decided to build around them.”
Pharmacy organizations also realize that the pharmacist is more
important than ever to consumers. The National Association of
Chain Drug Stores promotes the pharmacist role as “medication
therapy experts” and offers best-practice suggestions to its member
pharmacists in working directly with patients in medication therapy management, or MTM. That plan includes reviewing medications with patients, developing a personal medication record and
action plan for each patient, and working with doctors to resolve
While many pharmacists already do those things, it is becoming
more structured. Target, for instance, is piloting a formal program,
now testing in several stores, that uses MTM.
“The expectation of what a pharmacist should be to customers
has increased over the past few years,” said Jose Barra, senior VPhealth and beauty, Target Corp. “Our pharmacists are more available to guests, they take more time with each customer.We encourage them to be proactive. They dispense advice on prescription
drugs, but also on over-the-counter drugs as well.” The whole
mindset is rather than just helping customers get better, Target
helps them stay healthy, he said.
Mr. Barra described the Target pharmacy guest profile as a wide
spectrum with the sweet spot the mom with two kids, who in some
cases might also be providing care for aging parents. That’s where
programs like its trademark ClearRx system—with easy-to-read
labels, simple patient info cards on the back and color-coded rings
around the neck of the bottle (meant to distinguish each member of
the household’s prescriptions)—won the Design of the Decade
award from the Industrial Designers Society of America. The system works in multi-generational busy households and is easier for
older consumers to understand.
RISE OF GENERICS
Whether it is due to drugs going off patent or from pressure by
health-care management companies to cut costs or by consumers
looking for less expensive options, the use of generic drugs is growing by leaps and bounds. In 2010, 72% of all prescriptions dispensed were generics, up from 68% the year before.
The rise in generic drugs has played a role in the rise of the pharmacist. With so many generics bearing complex chemical names,
and even more about to flood the market, the potential for confusion is high. Pharmacists can fill that role of balancing price advantages with health advantages—and not just for prescription drugs
but for OTC as well.
“Eighty-two percent of people say they buy the over-the-counter drug recommended by their pharmacist. And pharmacists tend
to favor prescription-drug-to-over-the-counter switches because of
their visibility and long safety track records,” Palio’s Mr. McCoy
said.“Look at Zantac, Prilosec, Zyrtec—when a well-known branded drug goes OTC, it allows the marketer to continue marketing
under the name. There is still value in that brand name.”
We’ve all seen, or been the target of, retail pharmacy efforts to get
your “dance card” of prescriptions. In the past, many different
pharmacies have offered cash back or other in-store discounts for
switching. And while some still do, the current trend in pharmacy
advertising is more about establishing trust and helping customers
figure out the ever-changing world of health care.
CVS Pharmacy, for instance, is currently offering advice as its
bonus for new or transferred prescriptions. Those new customers
can get its Care 1on1 service, which is a personal review by your
local pharmacist to talk about “topics related to savings, safety and
Among the five retailers that spend the most on pharmacyrelated ads, No. 1 Walgreen Co. increased spending a bit from 2009
to 2010, but Nos. 2 and 3, CVS Caremark Corp. and Walmart
Stores, respectively, dropped spending by more than 30% each,
according to Kantar Media data. (CVS and Walmart declined
requests for interviews for this story.) However, Rite Aid Corp. and
Target,the No.4 and 5 ad spenders,respectively,both increased their
ad spending fairly significantly. Supermarkets are excluded from
this ad spending ranking. But pharmacies inside grocery stores
account for about $13.3 billion in sales.
Walmart, which sparked the initial pharmacy marketing war
with its $4 generic prescription promotions five years ago, still
offers a $10 gift card for online prescription transfers with home
delivery. Its move, although controversial, forced mass-merchant
pharmacy retailers—and eventually some drug stores—to make
the same offer.
Rite Aid is finding success with its Wellness+ lifestyle marketing and loyalty program. Rite Aid just launched its first conditionspecific Wellness+ for diabetes in collaboration with WebMD, offering free lifestyle management tools as well as a welcome package
with $100 in savings. Meanwhile, Rite Aid’s crossover from pharmacy to other in-store shopping is high, with almost 90% of its
Wellness+ card holders shopping both sides of the store. Its tagline,
reflecting its take on the importance of a quality relationship
between pharmacy and customer is, “With us, it’s personal.”
“We’ve got an aging population and, to be honest, an overweight population. People are starting to have chronic conditions
they need medication for. They go to the drugstore once a month,
or even more, to pick up scrips. Now the retailer knows they can get
customers to the store 12 times a year, whereas before it may have
only been three or four times,” Mr. McCoy said. “It’s a real opportunity to sell ‘front of the store,’ as it used to be called.”
BABY BOOMERS ARE TAKING ON NEW HEALTH-CARE RESPONSIBILITIES
Caregivers (population in thousands) for those 65 or older increased 8% in 2011.
On average these caregivers are 55; 62% of them are female; 62% are married.
Source: Kantar Media’s 2011 MARS OTC/DTC Study.
| October 17, 2011 | 15
Customer service is important to shoppers at pharmacies, as are
good prices. Opportunities to speak with the pharmacy staff and
brief wait times for prescription refills improve satisfaction.
The fifth annual pharmacy report from J.D. Power and
Associates released in September 2011 found that customers have
higher than ever expectations when it comes to pharmacy shopping
Last year, for instance, customer satisfaction increased when the
wait time was less than seven minutes for a prescription. However,
this year customer satisfaction decreased with wait time of just
three minutes for a prescription.
“Customers are expecting more from their brick-and-mortar
pharmacy—not just in terms of wait time, but also in terms of contact with the pharmacist and pharmacy staff,” said Rick Millard, senior director of the health care practice at J.D. Power and Associates, in
a press release.
“In fact, brick-and-mortar pharmacies are able to better differentiate themselves by offering additional services from the pharmacy
staff,” he said. “These personal contacts may help distinguish the
store experience as satisfying for pharmacy customers.”
Ranked by total number of U.S. retail prescriptions, 2010 (numbers in millions).
RANK PRESCRIPTION DRUG, MANUFACTURER(S)
RETAIL PRESCRIPTIONS IN MILLIONS
2 . lisinopril,Lupin Pharmaceuticals
High blood pressure
3 . simvastatin,Lupin Pharmaceuticals and Teva Pharmaceuticals
4 . levothyroxine,Mylan Pharmaceuticals
5 . amoxicillin,Sandoz
6 . amlodipine besylate,Mylan Pharmaceuticals and Greenstone
High blood pressure
7 . azithromycin,Greenstone and Sandoz
8 . alprazolam,Sandoz
9 . hydrochlorothiazide,Ivax Pharmaceuticals
High blood pressure
10 . omeprazole,Mylan Pharmaceuticals
Gastroesophageal reflux disease
11 . metformin,Teva Pharmaceuticals and Zydus Pharmaceuticals
12 . Lipitor,Pfizer
13 . furosemide oral,Mylan Pharma. and Ranbaxy Pharma.
High blood pressure
14 . metoprolol tartrate, Mylan Pharmaceuticals
High blood pressure, angina
15 . atenolol,Sandoz and Mylan Pharmaceuticals
High blood pressure, angina
16 . sertraline,Greenstone
17 . metoprolol succinate,Par Pharm. Cos. and Watson Pharma.
High blood pressure
18 . zolpidem tartrate,Teva Pharmaceuticals
Mental health, sleep disorder
19 . oxycodone/acetaminophen,Mallinckrodt Pharmaceuticals
20 . citalopram HBr,Torrent Pharmaceuticals
Mental health, depression
1 . hydrocodone/acetaminophen,Mallinckrodt Ph.; Watson Ph.
Mental health, anxiety
Mental health, depression
Source: SDI. Data from Advertising Age sibling Modern Healthcare, June 13, 2011. Note: Manufacturers indicated are majority manufacturer. Numbers rounded. For more information about the data used to
compile this list, contact: SDI, 1 SDI Drive, Plymouth Meeting, Pa. 19462; 610-834-0800; sdihealth.com; also Special Projects/Research Editor Rebecca Mielcarski, [email protected]
16 | October 17, 2011 |
Pharmacy benefits managers
Revenue,prescriptions filled and the dominance of generics in 2010.
LARGEST PHARMACY BENEFIT MANAGERS
Ranked by 2010 revenue from unbundled PBM services. Dollars in millions.
Percentages of prescriptions filled for all companies listed.
Medco Health Solutions Franklin Lakes, N.J.
CVS Caremark Corp. Woonsocket, R.I.
Express Scripts St. Louis
Prescription Solutions Irvine, Calif.
Catalyst Rx Rockville, Md.
informedRx Lisle, Ill.
Envision Pharmaceutical Services Twinsburg, Ohio
National Pharmaceutical Services Omaha, Neb.
PRESCRIPTIONS FILLED WITH
Percentages of prescriptions filled with generics by top 10 PBMs.
Pharmacy Data Management Poland, Ohio
PRESCRIPTIONS FILLED BY PBM
National Pharmaceutical Services
Ranked by number of prescriptions filled in 2010.
Pharmacy Data Management
Medco Health Solutions
CVS Caremark Corp.
Envision Pharmaceutical Services
CVS Caremark Corp.
Medco Health Solutions
Envision Pharmaceutical Services
Source: Business Insurance survey. From Sept. 19, 2011, report. 1. Business Insurance estimate. Business Insurance is a sibling publication of Advertising Age. Visit Business Insurance Research Center: businessinsurance.com/directories.
| October 17, 2011 | 17
Measuring how well pharmaceutical TV ads retain viewers.
Retention is better if viewers have a condition or know someone who does.
tuneaway is the metric that defines the percentage of audience
watching a TV show that changes channels when a commercial starts.
As Jeff Boehme, chief research officer at Kantar Media Audiences
North America, explains: “The second an ad begins, what do people
do? We know that dramas generally have less tuneway than comedies.
For commercials, the second an ad starts we can segment by category
and by brand how well commercials are retaining viewers.”
Tuneaway is high across most pharma categories. Kantar Media
data show most channel changing occurs when stop smoking,
impotence and anti-depression drug ads begin, with more than 6%
of audience checking out. That’s more than double the average 3%
tuneaway for all commercials. Only wrinkle removers and stomach
medications beat the average, at 2.2% and 2.5%, respectively.
“There are a lot of reasons why people might tune out of an ad.
While the media environment has the strongest influence on ad
avoidance, we see audiences reacting to specific creative messages
and topics in very deliberate ways,” Mr. Boehme said.
“We can measure how audiences respond, and how quickly they
change the channel or stay tuned.”
Kantar Media also measures overall retention—that is, not only
that first second when people tuneaway, but the overall audience
that stays with an ad for the full duration. Kantar Media takes that
measure of overall TV ad tuning and compares it with that TV
show’s total audience to calculate commercial tuning index (CTI).
According to this metric, pharma marketers seem to have trouble
The industry average is about 95% or a 95 index, and only
osteoporosis and overactive bladder commercials are close to that, at
just under 95%. Ads most likely to cause consumers to leave, with
almost 9% of audiences going elsewhere, are for contraceptives and
hypotrichosis (eye-lash growing).
“Effectiveness is about relevancy. If it’s a drug for asthma and
you or no one in your family has asthma, you’re more likely to
tune out,” Mr. Boehme said. “From an advertising perspective, it
really says they could do better at defining the target audience, and
we now have the data to know how.”
PHARMA COMMERCIALS: AUDIENCE TUNEAWAY AND RETENTION
Tuneaway: Commercials with the highest tuneaways. Smoking
cessation, impotence and anti-depression get tuned out most.
Retention (CTI):Index of commercial’s ability to keep audience for
spot’s 30-second duration. Overactive bladder and osteoporosis
ads do best.
Smoking cessation aids
Overactive bladder treatments
Chronic dry eye treatments
Mental health medications
Fibromyalgia pain treatments
Chronic obstructive pulmonary disease
Sleep disorder medications
Chronic obstructive pulmonary disease
Source: Kantar Media Audiences, which uses return path data (RPD) from a base of households with set-top boxes.
18 | October 17, 2011 |